How long has it been since you've been preparing medications for people living with HIV?
I've been working with people living with HIV professionally for four and a half years. I graduated from pharmacy school in 1999. I moved out to Seattle and worked at a Walgreens pharmacy for a year. After that job, I moved over to the Madison Clinic, and I've been there since 2001. I really enjoy working at the Madison Clinic. When I came to Harborview Medical Center, they asked me what I was interested in. I had a personal perspective from working with people living with HIV as a residential assistant at David's House in Toledo, Ohio before I graduated. I was also the president of the Gay and Lesbian organization in school and we did HIV-related events.
What was your experience at David's House?
When I was working there, I was in school, and I was overwhelmed and I didn't think I was qualified for my position. There were between three and five residents living there when I was working. I thought it was a lot of responsibility; but I ended up just hanging out working a 10-hour shift on the weekend. I was paid to take care of the house, I was a friend to the clients and gave assistance getting people down the stairs, or making them lunch. The clients would talk to me about what they were up to. My role there included being the someone there for them to talk to. I wasn't there often enough for them to go to me for counseling on big issues, but we got along well.
What is the patient demographic of your clinic?
Madison Clinic has about 1,200 to 1,400 clients. In general, I would say the population of the clinic is made up of more gay men, but we are a catch-all county hospital, anyone that can't get care elsewhere. We are the largest HIV facility in the Northwest. Everyone that comes here has HIV, but the patients are diverse; women, Latinos, some African Americans. Their care is also varied; some people are just starting on meds, some aren't on them yet, some people have been taking them for 20 years.
Does your most successful work come as a result of working in a team environment?
There is definitely a team environment at my job. I work in a great pharmacy full of hard working technicians and a really insightful clinical pharmacist. The pharmacy is just one part of the clinic, which also has social workers, financial advocates, a nutritionist, several psychiatrists, physicians, nurse practitioners, nurses and a whole bunch of other people, all of whom help coordinate the best care for our patients.
The Madison clinic is very well-integrated, and it helps because everyone is located in the same place. All the providers; nurses, nutritionists, psychiatry, social work, anyone who has a question about a medication or a problem can just stop by the pharmacy. The information goes both ways; if a client discusses having problems with their diet, instead of just sending them off to find the answer themselves, I can call the nutritionist for them.
Within the pharmacy there is a lot of teamwork going on. We have a distribution
team and a clinical pharmacy team. I do distribution, that's how people
know me. I really enjoy working with the clients and greeting them at
the window. I always take time to see what they are up to and sometimes
we are really busy so they appreciate that I take that time out of my
Why do you think people with HIV nominated you as their favorite pharmacist?
I think the clients trust me; I'm friendly and easygoing so they feel comfortable asking questions when they pick up their meds, and I try to smile and greet most clients who stop by the window.
Is there anything special you try to do for people living with HIV when they come to pick up their medications?
We make sure the clients are getting all the meds they need, when they need them. We check to see if clients are picking up their meds in a timely manner to monitor adherence. When clients pick up their meds for the first time they have already been initiated in a pre-HAART (Highly Active Antiretroviral Therapy) program initiated a few weeks before they start, where the client has the opportunity to sit down with someone from each section of the clinic. In the pharmacy, we like to check in periodically to see how things are going; if there are any side effects, adherence issues or other questions. For some clients we prepare medi-set boxes and dispense those to the client full of all the meds they need for a two week period.
Do you find that prepping medications for your patients helps with their adherence?
I think that is a really nice thing that we do. Weekly boxes are filled for any clients who are overwhelmed by too many medications. The service basically takes the stress off the clients as to if they are taking their regimen correctly. They can pick the boxes up every couple of weeks. The first couple of hours of everyday I work at the Madison clinic, I fill those boxes.
If I were to follow you for a week, what would I observe you doing?
At the Madison clinic you would see me preparing medi-sets, entering and checking prescriptions, counseling on medications, answering provider and patient questions. I also organize the HVTN (HIV Vaccine Trials Network) pharmacy, preparing and labeling trial vaccines, administering trial vaccines. I'm a preceptor for a pharmacy student, they are required to do an internship, overseen by a preceptor, she comes in once a week and I make sure she is getting the nuts-and-bolts of HIV pharmacy. We also have externship students who get more of a clinical pharmacy experience. My student has a whole list of things that are required to be taught by me. I see those as being very elemental and necessary, like how to do a transfer or enter a prescription, counsel patients on a prescription. But I think it is more important to teach how to be available to the patients. I try to be a role model, give her more then specific directions, but show her what a difference quality care makes. There are a lot of things to learn about HIV meds, and we go through all of that. She is actually working in the pharmacy; pulling things off the shelf, and counseling patients.
Also, I'm involved with Project PAL, which is an adherence study. It is a study evaluating people who have started or switched medications. They are randomized to receive a beeper or peer support. The peer support is made up of a group of people who have volunteered to help the study. They contact the patient to support them through the start of their medications. Some patients in the study get both a beeper and a peer. It is a social intervention with a purpose to see if those ideas will help people stick with taking their meds. I'm a very small part of the study, but it is run by psychology students who don't know too much about HIV medications. It's cool to be involved.
What is the worst thing about your job?
Bureaucracy. I work for the county hospital, which has a constant budget crunch and upper management tweaking what we do and not being responsive to the needs that are required for quality patient care, but the financial needs of the hospital. It's frustrating to work in an environment where you can't always get what you need, but you'll be forced to prioritize less important things. I think a lot of different people could identify with what I experience. Anyone who has a bunch of bosses above them, all managing at once, knows it can be a hassle.
What is the biggest challenge you face as a pharmacist?
Keeping up on all the latest developments and remembering what I've already learned. Treatments are constantly changing; new ones are being added or we need a new way to treat a side effect, which can get a little overwhelming. I keep up with developments by reading the latest resources that provide breakthrough information. I review everything, and I utilize the resources, but there is so much that it is a constant challenge. There are a lot of resources out there. Drug interactions are a big part of what I do, even if the patient is on an herbal supplement. Primarily we are looking for anything that needs to be closely monitored. We'll watch their labs and make sure they are coming in to get them done. We answer a lot of questions from providers. Sometimes people don't pick up their meds and we try to get the scoop from the patients. If someone does admit to non-adherence, depending on how bad it is we might just tell them again how to take it correctly. We try to make it constructive, tell them what is going on without giving them a lecture. Sometimes you end up just giving them a lecture. We'll let the providers know, especially for repeat offenders.
What do you think is the biggest risk factor for HIV?
Being part of a high risk group and letting your guard down. HIV is merciless and when you're part of a high risk group you have to be relentless about protecting yourself and your community.
What do you think are the biggest problems people with HIV face today?
The world-wide problems are prejudices associated with the disease and a lack of access to medications.
What is the most memorable thing you have learned from people living with HIV?
Love each other while you can.
How do you maintain a positive outlook and avoid burning out?
I'm fortunate to have started my career after great advancement in treatments, so I haven't seen the devastation, which was the reality to those working in HIV care in the past.
If you weren't a pharmacist, what would your profession be?
Counselor, social worker or teacher.
Would you like to dedicate this award to anyone?
My Dad and Grandpa Keck.
Where did you grow up?
Berlin Center, Ohio (rural northeast Ohio, population, around 800).
What did you want to be when you were a kid?
I wanted to be a pediatrician.
What kind of work do your parents do?
My mom is beautician and my dad is a tool and dye maker at General Motors.
Have you had any other types of jobs besides pharmacy?
I was a barista, recreation center employee, bus boy and lawn-boy.
Who have been the most influential people in your life, personally and professionally?
In general, great leaders have influenced me, such as the Dalai Lama. In my day-to-day life, my family is the biggest influence. There are so many different types of people all loving and teaching me and trying to get along with each other. I also work with a lot of people who I find inspiration in. There is a physician I know named Dr. Harrington, who interacts on a personal level, he's very friendly, and always jokes around. He is a really great provider because of how he interacts with his patients and everyone else. I try to emulate him, as well as anyone else I encounter who is humorous or thoughtful.
When you are able to get some spare time, what are your hobbies?
I like to watch movies, hang out with friends or exercise.
Do you have a partner? Children? Pets?
Yes, Sergio! Sadly, I don't have any pets, but I would love to have two cats, a dog and a baby!
Where do you live?
Seattle, which is great city living full of different people to watch and lots to do. It is definitely my home, it is beautiful out here. In comparison to where I grew up, the physical beauty in Seattle is amazing. There is a lot of water and green. I've enjoyed the people I've met, there is a lot happening politically and socially. I really enjoy the international film festival. There is a night of ballroom dancing, mixed with salsa and line dancing, I've been going to that recently. I just bought a condo, so I'm getting settled in.
If you could live anywhere (besides where you live now) where would you locate yourself?
Anywhere in South America (Peru, Chile, Argentina) as long as Sergio was there.
What's the best vacation you've ever had?
Hawaii, this year.
What's the biggest adventure you ever had?
Chile, last year.
What are you currently reading?
I read lots of magazines, but I'm reading Guns, Germs, and Steel: The Fates of Human Societies by Jared Diamond, poetry by Pablo Neruda, Shambhala Sun, Utne Reader, back issues of NEST.
What kind of music do you listen to?
I mostly listen to pop music, like Bright Eyes, The Stars, Brazilian Girls, The Magnetic Fields. There are a lot of good shows around this area.